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Company

Name:
Street Address:
City:
State:
Zip Code:

Company Contact

Name:
Title:
Telephone/Cell:
Email:

Alerts

In the event of an emergency, employees are alerted by (check all that apply)
The Sounding of an alarm
Public Address system announcement
Verbal Announcement
Other

Enter Description of the Other Alert(s) Here

Identify the emergency signal for each emergency situation (i.e. earthquake, fire, general evacuation)

Enter a Description of the Alarm for Each Emergency Situation

Policy

In the event of fire or other emergency, ALL employees shall evacuate immediately.
The policy of this establishment in the event of fire or other emergency is:

Enter a More Detailed Policy Statement

Routes

In the event of an emergency, employees shall evacuate by means of the nearest available marked exit.
In the event of an emergency, employees shall evacuate:

Enter a Statement Describing Means of Evacuation and Evacuation Routes

Extinguishers

Portable fire extinguishers are provided in the workplace for employee use. In the event of fire, any employee may use extinguishers to attempt to extinguish the fire before evacuating.
Employees are not authorized to use any portable fire extinguisher that may be present to fight fires. In the event of fire, employees are to evacuate immediately.
In the event of a fire, the following individuals are authorized to use portable fire extinguishers to attempt to extinguish fires before evacuating:

Enter a Statement Describing Employees (by name or job) who are designated to use fire extinguishers

Operations

Critical operations shutdown procedures are not required, because no employees are authorized to delay evacuation for this purpose.
In the event of an emergency, the following employees are to remain in the workplace to shutdown or monitor critical operations before they evacuate:

Enter a Statement Describing Employees (by name or job) who are designated to remain

Duties

No employees are assigned to perform medical or rescue duties during emergency evacuation situations.
The following employees are to perform rescue or medical duties during an emergency:

Enter a Statement Describing Employees (by name or job) who are responsible for rescue and medical assistance

Assembly

After an emergency evacuation, employees are to gather in the following location(s):

Enter Description of Location Here

Accounting

After an emergency evacuation, the procedure for accounting for all employees is:

Enter Description of Accounting Procedure Here

More...

Enter Additional Evacuation Plan and Procedures

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